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postpartum heart failure?

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postpartum heart failure?

Postby expert@preeclampsia.org » Thu Jul 15, 2010 12:59 am

by expert@preeclampsia.org (322 Posts), Thu Jul 15, 2010 12:59 am

Hi there,

I had a few complications throughout my pregnancy, namely gestational diabetes and preterm labor. My BP was always great throughout my entire pregnancy. I had no swelling whatsoever before giving birth and only gained 13 pounds. I had a long and tough labor (36 hours) and after 3 hours of pushing I developed corioamniotisis. I was given a c-section and was recovering well.

1 day PP I noticed that I was swelling horribly. My docs said it was normal and not to worry. I also noticed I was getting shortness of breath but was told that all my organs were going back into place and not to worry. 5 days PP I decided to go to the ER as I was still horribly swollen, still short of breath and just didn't feel "right."

I was believed to have had PP Cardiomyopathy because of my BNP of 425 at check in and also an x-ray showing fluid in my lungs and a possibly enlarged heart. At check in I was also 20 pounds heavier (from fluid) than I was when I gave birth. I was readmitted and shortly after my BP shot up to 180/110 and I got the worst headache of my life which started in my neck and migrated right to the front of my head between my eyes. The doctors diagnosed me with PP Pre-e and confirmed with a 24 hour urine test. After my BP got under control, I lost 13 pounds of fluid within 24 hours.

I was given an echo the next morning just to check out my heart and my EF was fine, ruling out PPCM however it did show mild diastolic dysfunction. My doctors assumed it was because of the Pre-e and did not worry about it. I got another echo 10 days later (to ease my mind) and my cardio said it had just the slightest bit of diastolic dysfunction but knowing that I was just pregnant, he would not worry about it. I had my BNP redrawn at 7 weeks PP and it was down to a 7.

I have been told by a few doctors that I experienced PP heart failure due to the pre-e. I believe this was the case and also the reason for the diastolic dysfunction and high BNP.

My cardiologist thinks that everything should be back to normal now, in terms of my diastolic functioning. Would you agree that this is what happened and that since my BNP is back down to normal that my function was temporarily compromised because of the pre-e and should be back to normal?

Thanks for your help!
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Re : postpartum heart failure?

Postby expert@preeclampsia.org » Thu Jul 15, 2010 01:00 pm

by expert@preeclampsia.org (322 Posts), Thu Jul 15, 2010 01:00 pm

If this is peripartum cardiomyopathy, the recovery rate is about 50%.

It is hard to rule out peripartum cardiomyopathy. If she has a reduced ejection fraction with new onset around pregnancy, she meets the criteria. It is our impression that dysfunction associated with hypertension has a better prognosis - especially if treatment includes BP control and treatment with an ACE-inhibitor and a ß-blocker.

6 months is the critical time for recovery. If not recovered by 6 months - prognosis much worse.

There remain significant questions and different opinions regarding a possible subsequent pregnancy.
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Posts: 322
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